Use of In Situ Simulation to Improve Emergency Department Readiness for the COVID-19 Pandemic.

INTRODUCTION: During the world-wide coronavirus disease 2019 (COVID-19) outbreak, there is an urgent need to rapidly increase the readiness of hospitals. Emergency departments (EDs) are at high risk of facing unusual situations and need to prepare extensively in order to minimize risks to health care providers (HCPs) and patients. In situ simulation is a well-known method used in training to detect system gaps that could threaten safety. STUDY OBJECTIVES: One objective is to identify gaps, test hospital systems, and inform necessary modifications to the standard processes required by patients with COVID-19 presenting at the hospital. The other objective is to improve ED staff confidence in managing such patients, and to increase their skills in basic and advanced airway management and proper personal protective equipment (PPE) techniques. METHODS: This is a quasi-experimental study in which 20 unannounced mock codes were carried out in ED resuscitation and isolation rooms. A checklist was designed, validated, and used to evaluate team performances in three areas: donning, basic and advanced airway skills, and doffing. A pre- and post-intervention survey was used to evaluate staff members' perceived knowledge of ED procedures related to COVID-19 and their airway management skills. RESULTS: A total of 20 mock codes were conducted in the ED. Overall, 16 issues that posed potential harm to staff or patients were identified and prioritized for immediate resolution. Approximately 57.4% of HCPs felt comfortable dealing with suspected/confirmed, unstable COVID-19 cases after mock codes, compared with 33.3% beforehand (P = .033). Of ED HCPs, 44.4% felt comfortable performing airway procedures for suspected/confirmed COVID-19 cases after mock codes compared with 29.6% beforehand. Performance of different skills was observed to be variable following the 20 mock codes. Skills with improved performance included: request of chest x-ray after intubation (88.0%), intubation done by the most experienced ED physician (84.5%), and correct sequence and procedure of PPE (79.0%). CONCLUSION: Mock codes identified significant defects, most of which were easily fixed. They included critical equipment availability, transporting beds that were too large to fit through doors, and location of biohazard bins. Repeated mock codes improved ED staff confidence in dealing with patients, in addition to performance of certain skills. In situ simulation proves to be an effective method for increasing the readiness of the ED to address the COVID-19 pandemic and other infection outbreaks.

The prevalence and associated factors of depression among medical students of Saudi Arabia: A systematic review.

The main purpose of our review study was to estimate depression prevalence among Saudi Arabian medical students according to the published articles and try to reveal the main associated factors. A systematic search was performed through PubMed/Medline and Google Scholar databases. A review of 18 studies published between January 2010 and March 2019 was composed of the following selection of necessary articles approved by PICO (population, intervention, control, and outcomes) criteria. The prevalence of depression among medical students of Saudi Arabia ranged from 30.9% to 77.6% with a mean prevalence of 51.5%. Depression severity was evaluated by various questionnaires, so we summarized the extracted data and revealed that medical students tend to have moderate to severe depression to a greater extent than mild depressive symptoms (33.27% vs 29.9%). The findings of this review suggest a high incidence of depression among medical students and the influence of associate sociodemographic factors. Females are considered to be at a higher risk of depression. First-year medical students are the most susceptible to develop depressive symptoms. Smoking is strongly associated with depression severity. Marital status, eating habits, usage of stimulants, and sleep disturbances are within significant findings of our review study.

General public knowledge and use of dietary supplements in Riyadh, Saudi Arabia.

CONTEXT: Dietary supplements is a growing industry, pharmaceuticals are having several types of similar supplements and multivitamins as over-the-counter products, a complete diet is necessary for a healthy body which leads to the usage of supplements or multivitamins complementing diets as needed, therefore leading to its encouraged usage among the population worldwide. AIMS: The study was aimed to determine the public's knowledge and their use of dietary supplements. SETTINGS AND DESIGN: A cross-sectional study was conducted among the general public of Riyadh, Saudi Arabia. METHODS AND MATERIALS: The sample consisted of 679 participants including 41% males and 59% females. The ethnicity of the participants is 100% Arabs. STATISTICAL ANALYSIS USED: SPSS. RESULTS: The sociodemographic data showed there were more female participants than males (59.1% vs. 40.9%), most of our participants had at least bachelor degree (64.4%), most of our participants had normal BMI (62.3%). 88.5% had knowledge on supplements and only 11.5% stated they were not aware at all. CONCLUSIONS: Dietary supplements and multivitamins consumption is prevalent among Saudi Arabian population. Our study suggests the majority of consumers understand the supportive role of dietary supplements and are aware of risks and side effects.

Favorable Response to Mirtazapine in John Cunningham Virus-related Gray Matter Lesion in a Patient with Human Immunodeficiency Virus.

Mirtazapine has recently emerged as a promising agent for the treatment of progressive multifocal leukoencephalopathy (PML). While there is no Class I evidence for its use, numerous case reports have illustrated mirtazapine's efficacy. True to its name, PML is known to occur mostly in the white matter of the brain as its causative agent, John Cunningham virus (JC virus), has a predilection for infecting glial cells. The virus replicates vigorously in oligodendrocytes and causes lysis of the glial cell culminating in demyelination. Therefore, gray matter involvement is rare. Mirtazapine's 5HT2A receptor blocking capacity is presumed to hinder JC virus' entry into glial cells. We report a case of a patient with human immunodeficiency virus (HIV) with predominantly gray matter lesions from JC virus reactivation. This case is the first reported case of gray matter PML in an Arabic patient who responded favorably to mirtazapine therapy.

Effect of academic stressors on eating habits among medical students in Riyadh, Saudi Arabia.

CONTEXT: Stress can be defined as an integral response of the organism to pressures from the internal or external environment with the aim to maintain homeostasis. Usually, it has a negative impact on human health. Medical students can feel stress during their preclinical studies due to overload of work such as assignments, lectures, and seminars. As a result, their appetite can be affected by skipping meals eating fast food. AIMS: The aim of this study was to assess the pattern of eating habits and to define its association with stress among medical students. SETTINGS AND DESIGN: This cross-sectional study was conducted among the medical students of Al-Imam Muhammed Ibn Saud Islamic University. SUBJECTS AND METHODS: The sample consist of 105 Arabian males (100%) with 21-year old being the average. We use questionnaires divided into three sections. STATISTICAL ANALYSIS USED: SPSS. RESULTS: We have confirmed three hypotheses: freshman would have Higher Stress Levels than sophomores and junior, the spread of fast food restaurants increases the chance for students to eat Unhealthy Foods, and the students Who Have High Stress Levels Would Eat More Unhealthy Foods Than Students Who Have Low Stress Levels. CONCLUSIONS: Our findings have revealed the importance to develop a specific intervention program with the aim to decrease the stress in medical students. We suggest also the development of accurate university programs with resources well programmed and well established, development of the educational program with the aim to promote healthy eating habits in medical students, the longitudinal courses should be converted to Blocks to decrease the Academic stress on students.

Effect of cell-phone radiofrequency on angiogenesis and cell invasion in human head and neck cancer cells.

BACKGROUND: Today, the cell phone is the most widespread technology globally. However, the outcome of cell-phone radiofrequency on head and neck cancer progression has not yet been explored. METHODS: The chorioallantoic membrane (CAM) and human head and neck cancer cell lines, FaDu and SCC25, were used to explore the outcome of cell-phone radiofrequency on angiogenesis, cell invasion, and colony formation of head and neck cancer cells, respectively. Western blot analysis was used to investigate the impact of the cell phone on the regulation of E-cadherin and Erk1/Erk2 genes. RESULTS: Our data revealed that cell-phone radiofrequency promotes angiogenesis of the CAM. In addition, the cell phone enhances cell invasion and colony formation of human head and neck cancer cells; this is accompanied by a downregulation of E-cadherin expression. More significantly, we found that the cell phone can activate Erk1/Erk2 in our experimental models. CONCLUSION: Our investigation reveals that cell-phone radiofrequency could enhance head and neck cancer by stimulating angiogenesis and cell invasion via Erk1/Erk2 activation.